Hypoglycemia unawareness

Why don’t I feel hypoglycemia?

Ling is a young lady in her prime, she also has another identity - a type 1 diabetic patient. She told the diabetes educator that she once tested her blood sugar at night and the result was only 33mg/dL. Miraculously, she didn’t feel anything, what's going on?

This is caused by counter-regulatory hormones and autonomic dysfunctions .When blood sugar is too low, the body responds with two physiological mechanisms:(1) the counter-regulatory hormones stimulate blood sugar increase and (2) the autonomic nervous system causes hypoglycemic symptoms. Patients are advised to quickly remedy hypoglycemia, symptoms caused by these physiological mechanisms are the earliest warnings. However, if the aforementioned physiological mechanisms are dysfunctional, no symptoms are presented during hypoglycemia. The following conditions are high risks for hypoglycemia unawareness: prolonged diabetes, autonomic neuropathies, recurrent hypoglycemia, and aggressive control of A1C within the ideal range. Studies show that hypoglycemia unawareness often happen to type 1 diabetic patient (approximately 40%).

How to prevent hypoglycemia unawareness?

1.Do not try to guess blood sugar based on how you feel. When your body does not exhibit hypoglycemia warning signs, you need to intensively monitor blood sugar. Try to test blood sugar before bed to prevent nocturnal hypoglycemia. Due to autonomic dysfunctions, it is very likely to lose the opportunities for sugar replenishment during sleep, which can easily cause hypoglycemic coma and death.

2.Eat regularly and have fixed servings to prevent hypoglycemia from delayed intake or insufficient intake.

3.Discuss a meal plan with a nutritionist.

4.Set a A1C target value with the medical team. Ideal or low A1C targets are more likely to cause hypoglycemia.

Reference: American Diabetes Association
                  World J Diabetes, vol.6 (7);2015, Jul 10
                  Diabetes.uk.co

hypoglycemia unawareness

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